Spinal cord stimulators are used to introduce a pulse of electric current around the spinal cord. The pulses interfere with brain activity and the nerve impulses that make a patient feel pain. The procedure is used to effectively treat chronic back pain by altering the way the brain perceives pain signals. The signals are altered by changing them to a “tingling” feeling.

Implanting the spinal cord stimulator is done as an outpatient procedure, and a trial implant is necessary first. The patient is given a local anesthetic and sedative. The pain management doctor in Florida inserts a stimulator lead around the spinal cord to offer a trial run of treatment. If the stimulator is effective and relief is noticeable, the Florida pain doctor implants a permanent stimulator.

Generally the stimulator battery/generator is implanted beneath the abdominal skin or just above the buttock area. The latest batteries are able to hold a charge for weeks at a time and are rechargeable from outside the skin. The spinal cord stimulator lead comes out from the battery and is placed around the spinal cord.

Once the stimulator is implanted, the patient works with the Florida pain doctor to determine the best possible pulse strength. The patient is instructed on how to use the device at home for maximum relief from pain. There are typically over a hundred possible programming options that can be tried. When the stimulator is in use, it feels tingly and warm. Rather than the patient experiencing pain in the back or legs, tingling sensations are felt.

Why Is Spinal Stimulation Done?

If a patient experiences chronic and severe pain, spinal cord stimulation is an option. The patient may have experienced failed back surgery followed by intense pain. In this case, spinal stimulation is offered when conservative treatments fail to provide relief.

Other reasons include severe nerve-related damage; pain and numbness or chronic pain in the back that does not subside after conservative treatment is provided. If further surgery is no longer an option, a spinal cord stimulator may the best last resort option possible.

How Effective is the Treatment?

Substantial evidence shows that spinal cord stimulators work very well to relieve pain. Patients with chronic back pain, failed back surgery syndrome, or complex regional pain have all been known to benefit from this form of treatment over 75% of the time.

Are there any risks involved?

As with any procedure there are risks involved, although minor. Possible risks may include the following:

Infection at the insertion site

Leakage of spinal fluid

Mild to moderate headaches

Problems with the bladder

Scar tissue build-up around the device insertion site or around the electrode

This is a conventional procedure for controlling pain arising from swollen nerve roots located in the spine. They are irritated due to discs leaking or due to bulges or to narrowing of the nerve canal. The epidural space is the area external to the sac containing the spinal cord and fluid. The epidural steroid injection is placed in this space in order to control pain, swelling and irritation of the nerve roots. The relief from pain can be long lasting in most cases. However, in some cases the relief is brief or none is obtained.

Before the Procedure

If you are scheduled for an epidural injection, in the upper back portion, the neck or the arm, you don’t have any food or liquid restriction. However, those taking medications in the form of blood thinners and aspirins should stop the medication 5 to 7 days prior to the procedure.

What does the Procedure Involve?

The Florida pain management doctor assesses the pain and then goes through your medical history. He will then examine you in relation to the pain symptoms and discuss the procedure, the risks and the benefits.

Once you are agreeable for the procedure, you will lie down on your stomach on a padded bed and a local anesthetic is used for numbing the specific area to be injected. A small needle is passed through the skin in order to locate the epidural space and the steroid is injected near the nerve roots that cause the pain. It is typically a painless procedure, but there may be some minor discomfort.

How long will it take to get Relief?

In case the epidural injection has been effective, you will see an improvement in the pain symptoms within a few days to a week after the procedure. However, it may not be effective for everyone. the local numbing medicine usually wears off after about 12 hours, and then the steroid will “kick in” within a couple days if it’s going to work. It may take a second or third procedure in a series over 4 to 6 weeks to obtain relief.

That series can be repeated every few months if the relief wears off. The relief may last a few weeks, or upwards of six months.

Steps to take after the procedure

At the procedure center, your vital signs will be monitored for 30 to 60 minutes after the procedure. You will need a ride to pick you up afterwards.

Are there any Risks to the Procedure?

The risks can be comparable to the risks of any other injection. There is a slight risk of infection, bleeding, nerve injury. It is possible in one out of hundred cases that the needle enters the sac with the fluid. In this case, you could have a headache for twenty four hours or so. There also may be slight increases in a patient’s blood sugars.

Epidural steroid injections have been of the best inventions over the past 50 years and have been a constant for sciatica treatment. Pain management doctors in Florida perform these injections hundreds of times daily.

A spinal cord stimulator, also called neurostimulation, is an excellent last option for those suffering from chronic pain and for whom further surgery is not an option. You may have tried pain medication management, physical therapy, nerve blocks, spinal surgery and more, but yet your pain is still at an undesirable level.

Spinal cord stimulators have been around since 1967 and are approved by the FDA for managing chronic pain in the back, neck, arms or legs. They’re also covered by most major health insurance plans, Workers Compensation and Medicare as well as Medicaid.

These devices have helped hundreds of thousands of those suffering from chronic pain to improve their quality of life and to get back to work along with decreasing the amount of pain medication necessary.

A Spinal cord stimulator lead and paddle.

The technology for neurostimulation works by altering pain signals before they get to the brain. The device involves a paddle that is made of silicone and placed around the spinal cord with small electrical pulses going through it. These mild electrical pulses decrease pain sensation and replace it with a more pleasant massaging sensation.

To be specific, there are three components to the spinal cord stimulator system. The first is a generator that is similar to a pacemaker and sends pulses to the leads. The generator also contains the battery component and is placed under the skin usually above the buttock area or around and under the abdomen.
The second component is the leads that has the paddle. These deliver pulses from the generator to the area around the spinal cord. It is placed into the epidural space, which is the space around style cord.

Spinal cord stimulator programmer/battery.

The third component of a spinal cord stimulator is the programmer. This is a handheld device that does not get implanted and ask like a remote control. It is able to change the programming for the device to help with better pain management.

Currently, a spinal cord stimulator device is recommended if the Florida pain management doctor runs out of other options. Surgery is no longer indicated, pain management has not been sufficient despite best efforts, and even pain medications are not abating the pain.

Initially a trial device is put into place and if that works, the permanent implant is scheduled after insurance approval. It is an outpatient procedure.

The overall success rate with spinal cord stimulation is over 60%, and if chronic pain has not been in place for many years it may be upwards of 80% satisfaction.
If you or a loved one is suffering from chronic pain, then a spinal cord stimulator may be for you.

It has been known for a long time that spinal cord stimulation for the lumbar spine is an excellent last resort treatment for pain relief. What has not been known is how well spinal cord stimulation works for chronic neck pain when the patient is no longer a candidate for surgery.

A recent study that was presented at the North American Neuromodulation Society showed that spinal cord stimulation for chronic neck pain in fact does work very well. Two large multicenter trials were performed and included over 600 patients. 38 patients ended up receiving the spinal cord stimulator implant in the neck. The diagnoses of the patients were varied, and included RSD, failed spine surgery syndrome, chronic radiculopathy, degenerative disc disease and failed neck disc surgery syndrome.

Patients were evaluated at multiple time points up to a year. By the six-month time frame, pain relief was at 60% while at the one year point rose to 67%. Over 60% reported good to excellent pain relief at all time points. Of note, this is extremely similar to the results obtained with lumbar spinal cord stimulation.

Only one person in the whole study described her pain relief as poor with a stimulator. Disability index scores were also significantly reduced and patient quality-of-life was dramatically improved at all time points evaluated. At the one year time point, three fourths of individuals said they would undergo the procedure again and would also recommend the procedure to others with chronic neck pain who had no surgical options.

This study fills a large gap in the treatment for chronic neck pain that has failed considerable treatment including surgery. These individuals often have to rely on hefty doses of narcotics and significant disability. With spinal cord stimulation for chronic neck pain, patients may be able to get back to work, decrease the amount of narcotics necessary for relief and increase their social lives and ability to play with their kids and pets.

For individuals with sciatica, epidural injections present one of the best treatment options for pain relief. The benefit of the injections comes from the anti-inflammatory effects of the cortisone. Here are a few key points of the injections.

It is been shown in studies that epidural injections work better for those with acute sciatica rather than chronic.

Interestingly, when an individual has pain during the epidural injection that goes down the leg, it is not definitive that a nerve root was touched. It may be that the facet joint or part of the disc was touched and that led to referred pain down the leg.

Real Time x-ray, known as fluoroscopy, should be used for all epidural steroid injections of the transforaminal nature. Otherwise, accuracy can be off by as much as 40%.

The placement of contrast prior to steroid injection is a very good idea to ensure the highest level of accuracy.

The transforaminal approach has shown better results than the interlaminar type of injections with regards to the number of procedures necessary to achieve pain relief.

Epidural injections work better in those patients who have had less than a year duration of pain.

There are no definitive studies showing the optimum number of injections necessary, or the amount and type of steroid medication to use.

Regardless of the type of epidural injection performed, it has been shown that epidural injections work well between 75 and 90% of the time. It may be that a series of injections is necessary to obtain optimal relief, and that series can be repeated every few months. While surgery for a disc herniation has a low risk profile, there are still risks involved.

** Disclaimer
The Florida Pain Network is not a healthcare provider and does not by itself form patient-physician relationships. It is a directory of medical providers who may be contacted for treatment. The Florida Pain Network cannot guarantee outcomes from being treated by these providers. None of the medical information provided on the site should be construed as individual medical advice or anything other than educational content or a medical provider directory.